Pleurectomy decortication is the preferred surgical procedure in pleural mesothelioma

Our plain-English summary of Pleurectomy decortication is the preferred surgical procedure in pleural mesothelioma, by M. Lapidot, R. Bueno (Translational Lung Cancer Research, 2023).

The study

• Authors: M. Lapidot, R. Bueno
• Journal: Translational Lung Cancer Research
• Published: 2023;12(2):190-192
• Type of article: Editorial, Comment
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This editorial, commissioned by the journal and not externally peer reviewed, reported no new data. The authors commented on a 20-year, single-center study of pleural mesothelioma surgery by Klotz et al. That study compared chemotherapy alone (56 patients), extrapleural pneumonectomy (EPP, which removes the lung) combined with chemotherapy and radiation (69 patients), and extended pleurectomy decortication (EPD, a lung-sparing operation) combined with heated chemotherapy in the chest and later chemotherapy (56 patients). As the editorial described it, overall survival was 38.1 months after EPD versus 24 months after EPP, and the EPP group had significantly more complications. The authors also cited their own earlier report on 355 pleurectomy decortication patients. Among them, one hundred and eighty-four epithelioid patients whose visible tumor was completely removed had better overall survival than 529 epithelioid patients treated earlier with EPP at the same institution. Median survival was longer than 2.5 years for epithelioid EPD patients versus 1.5 years in the EPP group. Noting the scarcity of properly planned trials, the authors supported EPD-based combined treatment for epithelioid mesothelioma. The article did not discuss asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial commentary on another published study (Klotz et al. 2022); commissioned by the journal and not externally peer reviewed; no original data
• Who was studied: No population of its own. The editorial discussed Klotz et al.'s 20-year, single-center series of pleural mesothelioma surgery. It also cited the editorial authors' own earlier series of 355 pleurectomy decortication patients, one hundred and eighty-four of them epithelioid patients with macroscopic complete resection, and an earlier cohort of 529 epithelioid patients who had EPP at the authors' institution.
• Main results:
  • Klotz et al.'s study, as described here, compared a chemotherapy-alone group of 56 patients, an EPP-based treatment group of 69 patients, and an EPD-based treatment group of 56 patients.
  • In Klotz et al.'s study, overall survival was 38.1 months in the EPD group versus 24 months in the EPP group, described as significantly longer.
  • In Klotz et al.'s study, complications around the time of surgery, including the rate of repeat operations, were significantly higher in the EPP group than in the EPD group.
  • In Klotz et al.'s study, EPD patients were significantly older: median age 67 [61 to 72] versus 59 [54 to 65] in the EPP group.
  • In Klotz et al.'s EPD group, macroscopic complete resection (removal of all visible disease) was achieved in 89%, with no deaths at 30 or 90 days.
  • In Klotz et al.'s multivariate analysis, only the EPD group had a significant impact on overall survival.
  • In the editorial authors' own earlier work, overall survival of one hundred and eighty-four epithelioid patients who underwent macroscopic complete resection was described as superior to that of an earlier cohort of 529 epithelioid patients who underwent EPP at the authors' institution.
  • In the editorial authors' own earlier work, median survival was longer than 2.5 years in epithelioid EPD patients, compared with 1.5 years in the EPP group.
  • In the editorial authors' own earlier work, epithelioid patients with T1 disease had a median survival of 69.8 months and a 5-year survival of 54.1%.
• The authors' conclusion: The authors supported Klotz et al.'s stance and stressed EPD-based multimodality treatment for epithelioid mesothelioma, based on retrospective and prospective cohort studies. They also called for continued improvement of patient selection.
• Limitations the authors state:
  • The authors noted a scarcity of properly planned clinical trials comparing chemotherapy with surgery-based multimodality treatment, or EPD with EPP.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Pleurectomy decortication for mesothelioma: The procedure of choice when possible — R.M. Flores (2016)
• Meta-Analysis of Different Procedures: The Importance of Recognizing the Spectrum of Pleurectomy/Decortication Techniques — C. Cao, D.H. Tian, et al. (2015)
• Is it time to consider pleurectomy and decortication as the only surgical treatment for malignant pleural mesothelioma? — M.J. Weyant (2012)
• Surgical indications for pleurectomy/decortication in pleural mesothelioma based on the newly revised 9th edition of the tumour-node-metastasis classification — M. Kanayama, M. Takenaka, et al. (2024)
• Pleurectomy/Decortication Versus Extrapleural Pneumonectomy in Pleural Mesothelioma: A Systematic Review and Meta-Analysis of Survival, Mortality, and Surgical Trends — M. Brivio, M. Chiari, et al. (2025)
• Prolonged survival and novel prognostic factors in women with pleural mesothelioma treated with extended pleurectomy decortication — M. Lapidot, E. Mazzola, et al. (2024)

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